TED GRIGGS

Dr. Erik Sundell , Ochsner Medical Center

The people who came back are sicker. More of them lack insurance. Once-promising healthcare reform efforts have stalled. Nineteen months after Hurricane Katrina, hospital emergency departments remain overburdened and continue to handle the majority of patients.

Welcome to The Big Easy, the city that care forgot.

"We're seeing an increased volume, both of patients walking in as well as patients arriving (by ambulance). Notably we're seeing an increase in psychiatric patients, and those have been our more challenging patients to take care of," said Dr. Erik Sundell of Ochsner Medical Center. "We're also seeing a larger percentage of patients without insurance than we had prior to 2005."

The increase in patients at Ochsner's emergency department shows no signs of slowing, Sundell said. The emergency department treated more people in February than in November and December.

"Every quarter we've had an increase in volume," Sundell said.

Dr. James Aiken, Director of the Homeland Defense Program at LSU Health Sciences Center in New Orleans and an LSUHSC emergency medicine physician, said University Hospital is treating an inordinate number of people who are either being diagnosed with cancer for the first time or who moved back home after having been diagnosed with cancer.

"In their minds, they mistakenly believe they can get similar care back in their hometown, and we can't do that to a large extent," Aiken said.

The sicker patients are adding to the burden borne by hospital emergency departments, Aiken said.

Ochsner is creating capacity by treating emergency patients outside the waiting rooms, Sundell said. But the hospital's biggest concern is that the more emergency room capacity the hospital creates, the more money it loses.

CityBusiness has reported that during the last two years, Touro, East Jefferson General Hospital, West Jefferson Medical Center and Ochsner Health System spent more than $174 million treating people who had no health insurance.

The hospitals have recovered less than one-tenth of that in reimbursements.

Aiken said the hospitals are still losing "a ton of money." Sometimes he wonders how long that can continue, how much longer every hospital can remain open.

"Maybe," he said, "it's just frustration talking down here."

Sundell said the situation is unlikely to improve until someone figures out how to compensate private hospitals for treating the uninsured or until the state provides a place for the uninsured to get care.

In any event, the number of hospital beds available is about 50 percent of what it was before the hurricane. The same percentage applies to physicians and nurses in private practice, and the numbers are going to get worse.

"I'm a board member of the Orleans Parish Medical Society, and our board is absolutely convinced those numbers are going to drop," Aiken said.

People wait to move until the kids are out of school, and that time is near, Aiken said.

Meanwhile, the physicians who left and have not come back probably aren't going to do so, Aiken said. Those people have planted roots in new communities, roots too deep to pull up, to return to an environment where the healthcare environment is just as uncertain now as it was shortly after the storm.

There has been no movement on the healthcare reform front since the beginning of the year, no offer of subsidies or help for physicians in maintaining their practices, Aiken said.

"There is no promise of anything," he said.

It's all so different from the hope that followed the initial planning process after the hurricane. The United States Public Health Service's strategic plan, Operation Phoenix, evolved into Bring New Orleans Back's healthcare committee report. The report and its guiding principles were adopted by the Louisiana Recovery Authority, presented to the Louisiana Health Care Redesign Collaborative and to Department of Health and Human Services Secretary Mike Leavitt, Aiken said.

And that is where progress … has … stalled.

The debate about healthcare reform has devolved into a fight over what exactly an academic medical center should entail, Aiken said.

"Speaking as a physician and as a citizen, I'm really sorry that there has to be really either-or in this," Aiken said. "To me, you take all of the guiding principles and you just decide how you're going to make it happen."

Louisiana is losing its opportunity, if it hasn't already, to create a model healthcare system for the rest of the country, Aiken said.

"And that's gone from frustration to just sadness, because it's all there," Aiken said.

Aiken said some positive developments have come from the hurricane. One of the best is the cooperation among all healthcare providers in the New Orleans region.

"We collaborate on a level that was absolutely unheard of before," Aiken said.

One needs to look no further than area hospitals' use of www.emsystem.com to coordinate emergency care.

Each day, every hospital lists information such as its capabilities and the time it takes to unload ambulances, Aiken said. When the tornado struck, the hospitals were able to get extra people in and to provide an up-to-date picture of where ambulances should bring each and every patient.

Emergency departments have also become more efficient, Aiken said. Each facility must use every ambulance and every bed as economically as possible.


May 2007